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654: Incidence of Postdural Puncture Headache Following Lumbar Puncture Using a 26g Atraupatical Spinal Needle, and 27g Pencil Point Spinal Needle
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654. Incidence of postdural puncture headache following lumbar puncture using a 26g atraupatical spinal needle, and 27g pencil point spinal needle S. Apiliogullari, F. Go¨k Dr. Faruk Sukan Obstetrics and Children’s Hospital, Anesthesiology and Intensive Care, Konya, Turkey Background and Aims: Postdural puncture headache (PDPH) after lumbar puncture (LP) is as common in children as adults. We studied to compare the incidence of PDPH in children aged 3-15, undergoing spinal anesthesia at Dr. Faruk Sukan Obstetrics and Children’s Hospital. Methods: A one year⬘ observational study of routine spinal anesthesia in 186 patients was conducted. Group I, n⫽ 100 (26-gauge, atraumaticneedle Atraucan®) and group II, n⫽86 (27G pencil point needle, Pencan®). Patients were exluded the study if the number of LP attempts ⬎1. Results: Incidence of PDPH was significantly less (1%) in group II when compared with to Group I (5%). Conclusions: We have confirmed a significant incidence of PDPH in 26G Atroucan group and suggest that a 27G pencil point needle can be used successfully for LP, with significantly reduced incidence of PDPH.
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Pediatrics
233
704. Involuntary movements following two different anaesthetic agents A. Govindarajan, N. Robson Birmingham Children’s Hospital, Anaesthesia, Birmingham, UK Background: Neuroexcitation with anaesthetic agents are an uncommon side effect1. We present an interesting case report about a young boy, who developed involuntary movements in the recovery room following two different anaesthetics. Episode 1: A14 year old healthy boy with no previous history of epilepsy or movement disorder had uneventful steroid joint injections under general anaesthesia with propofol, isoflurane and nitrous oxide. In the recovery room before regaining consciousness, he started to develop involuntary dystonic and writhing movements. After 45 minutes, it was terminated by intravenous injection of Trihexyphenydyl. He had an uneventful stay overnight in the hospital. Episode 2: He was asymptomatic and healthy for 18 months and then he returned for a repeat of his joint injections. Propofol was avoided and anaesthesia was induced and maintained with sevoflurane, nitrous oxide and oxygen. During attempted intravenous cannulation the boy started to have writhing movements oflimbs lasting 30 seconds later settled on its own. The rest of the anaestheticwas uneventful. In the recovery room, he started to have tonic clonic movementsof limbs for 5 minutes. No further intervention was done and it did not recur. Discussion: Propofol has long been accused of causing seizure like phenomenon2. In our case, the boy had a recurrence of seizures with sevoflurane based anaesthetic even after avoiding propofol. We review the relevant literature relating to the seizure like phenomenon caused by propofol and sevoflurane. We also discuss the issues relating to his future anaesthetics and his fitness to drive in future.
References 1) Sevoflurane and epileptiform EEG changes. Pediatric Anaesthesia. 2005 April; 15(4):266-74. 2) Seizure-likephenomena and propofol: a systematic review Neurology. 2002 May14;58(9):1327-32.
654. Incidence of postdural puncture headache following lumbar puncture using a 26g atraupatical spinal needle, and 27g pencil point spinal needle S. Apiliogullari, F. Go¨k Dr. Faruk Sukan Obstetrics and Children’s Hospital, Anesthesiology and Intensive Care, Konya, Turkey Background and Aims: Postdural puncture headache (PDPH) after lumbar puncture (LP) is as common in children as adults. We studied to compare the incidence of PDPH in children aged 3-15, undergoing spinal anesthesia at Dr. Faruk Sukan Obstetrics and Children’s Hospital. Methods: A one year⬘ observational study of routine spinal anesthesia in 186 patients was conducted. Group I, n⫽ 100 (26-gauge, atraumaticneedle Atraucan®) and group II, n⫽86 (27G pencil point needle, Pencan®). Patients were exluded the study if the number of LP attempts ⬎1. Results: Incidence of PDPH was significantly less (1%) in group II when compared with to Group I (5%). Conclusions: We have confirmed a significant incidence of PDPH in 26G Atroucan group and suggest that a 27G pencil point needle can be used successfully for LP, with significantly reduced incidence of PDPH.
•
Pediatrics
233
704. Involuntary movements following two different anaesthetic agents A. Govindarajan, N. Robson Birmingham Children’s Hospital, Anaesthesia, Birmingham, UK Background: Neuroexcitation with anaesthetic agents are an uncommon side effect1. We present an interesting case report about a young boy, who developed involuntary movements in the recovery room following two different anaesthetics. Episode 1: A14 year old healthy boy with no previous history of epilepsy or movement disorder had uneventful steroid joint injections under general anaesthesia with propofol, isoflurane and nitrous oxide. In the recovery room before regaining consciousness, he started to develop involuntary dystonic and writhing movements. After 45 minutes, it was terminated by intravenous injection of Trihexyphenydyl. He had an uneventful stay overnight in the hospital. Episode 2: He was asymptomatic and healthy for 18 months and then he returned for a repeat of his joint injections. Propofol was avoided and anaesthesia was induced and maintained with sevoflurane, nitrous oxide and oxygen. During attempted intravenous cannulation the boy started to have writhing movements oflimbs lasting 30 seconds later settled on its own. The rest of the anaestheticwas uneventful. In the recovery room, he started to have tonic clonic movementsof limbs for 5 minutes. No further intervention was done and it did not recur. Discussion: Propofol has long been accused of causing seizure like phenomenon2. In our case, the boy had a recurrence of seizures with sevoflurane based anaesthetic even after avoiding propofol. We review the relevant literature relating to the seizure like phenomenon caused by propofol and sevoflurane. We also discuss the issues relating to his future anaesthetics and his fitness to drive in future.
References 1) Sevoflurane and epileptiform EEG changes. Pediatric Anaesthesia. 2005 April; 15(4):266-74. 2) Seizure-likephenomena and propofol: a systematic review Neurology. 2002 May14;58(9):1327-32.